| NPI | 1649525692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0011759) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO PTL.0011759) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2023-07-17 |